Ocfs 6004-2026

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The document OCFS-6004 is a medical statement form required by the New York State Office of Children and Family Services for staff, volunteers, and household members involved in child day care programs. It outlines the necessary medical evaluations to ensure individuals do not pose health risks to children in care, including sections for health care providers to assess communicable diseases, psychiatric conditions, and physical capabilities. Additionally, it includes instructions for tuberculin testing and specifies roles within child care programs.

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Click ‘Get Form’ to open the ocfs 6004 in the editor.
Begin by filling in the Program Name and Facility ID Number at the top of the form. Ensure that you print clearly for easy readability.
Next, enter the Person’s Name and Date of Birth. This information is crucial for identifying the individual associated with this medical statement.
Select the TYPE OF PROGRAM from options such as Family Day Care or Group Family Day Care, and indicate the ROLE of the individual, whether they are a Provider, Volunteer, or Household Member.
The Medical Status section must be completed by a qualified health care provider. They will assess and sign off on any communicable diseases or physical conditions that may affect child care duties.
If applicable, complete the Tuberculin Test Information section on the reverse side. This includes test results and any necessary clarifications regarding health risks.
Finally, ensure that both sides of the form are signed where required before submitting it according to your program's instructions.

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Versions	Form popularity	Fillable & printable
2019	4.2 Satisfied (59 Votes)
2015	4.7 Satisfied (40 Votes)

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How do you fill out staff volunteer and household member medical statement online?

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What is the income limit for child care assistance in NY?

Income Requirements Family SizeAnnual Income Limit*Monthly Income Limit1$43,740$3,6452$59,160$4,9303$74,580$6,2154$90,000$7,5002 more rows

How do I contact OCFS in NY?

You can call 1-844-697-3505 to docHub the OCFS Human Services Call Center Helpline for the Bureau of Adult Services. Call center staff can answer basic questions and provide contact information about the Family-Type Homes for Adults program and the Adult Protective Services program.

What does the New York State Office of Children and Family Services do?

The agency provides a system of family support, juvenile justice, child care and child welfare services that promote the safety and well-being of children and adults.

ocfs medical form 6004

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Who oversees OCFS in NY?

Suzanne Miles-Gustave, Esq., was appointed acting commissioner of the New York State Office of Children and Family Services in December 2022. She concurrently serves as the agencys executive deputy commissioner, a role she was appointed to in July 2021.

What is OCFS in NY?

The Office of Children and Family Services serves New Yorks public by promoting the safety, permanency and well-being of our children, families and communities. We will achieve results by setting and enforcing policies, building partnerships, and funding and providing quality services.